<%-- 
    Document   : index
    Created on : 15 Nov 11, 20:13:58
    Author     : Aditya-Z
--%>

<%@page contentType="text/html" pageEncoding="UTF-8"%>
<!DOCTYPE html>
<html>
    <head>
        <meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
        <title>Daftar</title>
    </head>
    
    <body>
        
        <table width="200" style="background-url:img/header.jpg;width: 813; height: 166;">
        <tr>
            <td width="70%"><img src="img/header.jpg" width="813" height="166" alt="header"/>
            </td>
            <td width=100%><h1 align="center">Daftar</h1></td>
        </tr>
        </table>
        
       
        <form method ='post' action="akun?halaman=daftar">
           
                
                <table width=100% height="175" style="background-color:lavender;">
              
                 <tr>
                    <td width="10% height="45">Username  </td>
                    <td width=30%><label>
                    <input type='text' name='username' />
                     </label></td>
                 
                     <td rowspan="8" valign="top" width=100%><fieldset class="getstarted" align="justify"><legend><h2><font color="#ffa200">Get Started</font></h2></legend><font color="#3d3d3d">Segera Mendaftar untuk melakukan pertolongan pertama untuk Penyakit DHTD</font></fieldset></td>
                 
                 </tr>
                 
                
                <tr>
                    <td width=10% height="45">Umur  </td>
                    <td width=30%><label>
                    <input type='text' name='umur' />
                     </label></td>
                </tr>
                <tr>
                    <td width=10% height="45">Berat Badan  </td>
                    <td width=30%><label>
                    <input type='text' name='berdan' />
                     </label></td>
                </tr>
                <tr>
                    <td>Golongan Darah </td>
                    <td>
                 A <input name="goldar" type="radio" value="A" />
                  
                 B <input name="goldar" type="radio" value="B" />
                  
                  AB<input name="goldar" type="radio" value="AB" />
                  
                 O <input name="goldar" type="radio" value="O" />
                  </td>
                </tr>
                <tr>
                    <td width=10%>Password</td>
                    <td width=30%><label>
                    <input type="password" name="pass" />
                    </label></td>
                </tr>
               <tr>
                     <td width=10%>Ulangi Password </td>
                     <td width=30%><label>
                     <input type="password" name="pass1" />
                     </label></td>
                </tr>
                <tr>
                 <td>&nbsp;</td>
                 <td>&nbsp;</td>
                </tr>
                <tr>
                 <td><input type="submit" name="Daftar" value="Submit" /></td>
                 <td>&nbsp;</td>
                </tr>
                </table>
                
        </form>
            
            
        
    </body>
 <a href="akun?halaman=gologin">Kembali ke login</a>
</html>
